69 year old male with UNCONTROLLED SUGARS?DKA



C/O DIFFICULTY IN SWALLOWING SINCE 1 WEEK,

LOSS OF APETITE SINCE 1 WEEK

 DARK TARY STOOLS SINCE 1 WEEK

HOPI-PT WAS APPARENTLY ASYMPTOMATIC 12 YEARS BACK THEN HE HAD FEVER,LOOSE STOOLS WENT TO HOSPITAL AND DIAGNOSED WITH ?ACUTE GE  WITH DENOVO HTN.

3YEARS BACK PATIENT HAD FEVER AND GIDDINESS WENT TO LOCAL HOSPITAL AND DIAGNOSED WITH VIRAL PYREXIA WITH DENOVO DM.SINCE THEN PATIENT WAS ON IRREGULAR MEDICATION.

HE USED TO TAKE OHA'S AND ANTIHYPERTENSIVES,ON 7/2/22 PATIENT CAME TO GM OPD WITH HEADACHE AND LOSS OF APETITE WAS TREATED ON OP BASIS,AS PATIENT FEELS HIS ATTENDERS ARE NOT WILLING TO SPEND MONEY ON HIS HEALTH ,HE FOUGHT WITH THEM,THEY TOOK HIM TO PRIVATE HOSPITAL ,WHERE CT AND MRI BRAIN WAS DONE AND DIAGNOSED WITH ?NCC/TUBERCULOMA,OPTHAMOLOGY OPINION WAS TAKEN IN V/O RETRORBITAL PAIN AND DIAGNOSED WITH ?OCULAR TB AND PRESCRIBED WITH STEROIDS 
E/D PREDNISOLONE 6DROPS/DAY,
CYCLOPENTOLATE 3 DROPS/DAY,
TIMOLOL 2DROPS/DAY WITH TAB.OMNICORTIL 20 BD AND ALBENDAZOLE 400 BD  x 7 days.

NOW PATIENT PRESENTED WITH H/O DIFFICULTY IN SWALLOWING SOLIDS SINCE 1 WEEK,LOSS OF APETITE SINCE 1 WEEK,DARK TARY STOOLS -3 DAYS,FEVER SINCE 1 WEEK

PATIENT IS A KNOWN CASE OF HIV+VE .

TREATMENT H/O-
ON OHA'S -GLIMI-M1 SINCE 13 YEARS
ON ANTI HYPERTENSIVES-TELMA -H SINCE 12 YEARS
NO KNOWN DRUG ALLERGIES

PERSONAL H/O-
PT IS MODERATELY BUILT AND MODERATELY NOURISHED,

ALCOHOL-REGULAR,90-180 ML WHISKY SINCE 10 YEARS.

TOBBACO-CHEWABLE SINCE 6 YEARS

FAMILY H/O-NOT SIGNIFICANT

GENERAL EXAMINATION-
PT C/C/C
VITALS-
TEMP-102 F
PR-122 BPM
RR-38 CPM
BP-80/50 MM HG
SPO2-98%ON RA
GRBS-HIGH

S/E-
CVS-S1,S2 PRESENT,NO MURMURS
RS-BAE+,NVBS HEARD
P/A-,SOFT,NT,BOWEL SOUNDS
 PRESENT
CNS-NAD


Investigations-
Serology-
HIV-+VE


ECG-


DIAGNOSIS-?DKA

TREATMENT-
1.NBM TILL FURTHER ORDERS
2.IVF NS/0.45%NS @ 150 ML/HR
3.INJ HAI 6U/IV/STAT
    F/B
INJ HAI IN 49 ML NS @6 ML/HR
 TO MAINTAIN GRBS<250-150 MG/DL
4.INJ PAN 40 MG IV/OD
5.INJ THIAMINE 2 AMP IN 100 ML NS/IV/OD
6.INJ ZOFER 4 MG/IV/TID
7.INJ NEOMOL 1 GM/IV/SOS IF TEMPTEMP

ICU UPDATES
1/3/22

69YEAR/male

S-   C/o Hiccups And  Cough

O-
O/E:
No pallor/Icterus/Cyanosis/Clubbing/Generalised Lymphadenopathy/Pedal edema
Temp:Afebrile
PR:76bpm
BP:90/70 mm of hg
GRBS:- 204mg/dl
INPUT :- 3000ml
OUTPUT :- 1250ml
CVS:S1,S2 heard,no murmurs
RS:BAE+,NVBS heard
P/A:SOFT,NONTENDER,BS+

A-?DKA( resolving ) with ? NCC / TUBERCULOMA WITH TYPE 2 RESPIRATORY FAILURE ? OCCULAR TB

P-

1. Allow soft diet 

2. Inj      8am.   1pm    8pm
   HAI.     10U     10U.    10U
   NPH.     10U      -       10U

3. GRBS 2nd hrly 
4. IVF @ NS , RL @75ml/hr
5. INJ THIAMINE 1amp in 100ml NS IV/BD
6. Intermittent Bipap for 4 hr


PT WENT ON LAMA .


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